Increased serum levels of the S-100 protein are associated with hypoxic brain damage after cardiac arrest.
OBJECTIVE
Patients resuscitated from cardiac arrest have a high early mortality rate. Prognostic evaluation based on clinical observations is uncertain and would benefit from the use of biochemical markers of hypoxic brain damage. The astroglial protein S-100 is an established biochemical marker of central nervous system injury. The purpose of the present study was to validate the use of serum determinations of S-100 with regard to outcome after cardiac arrest.


METHODS
Levels of serum S-100 were measured with a radioimmunoassay in 41 patients the first 3 days after out-of-hospital cardiac arrest. The main outcome variable was fatal outcome within 14 days.


RESULTS
S-100 levels were increased after cardiac arrest compared with controls with the highest levels observed the first day. S-100 levels day 1 and 2 correlated to the degree of coma as well as to the time of anoxia. Seventeen patients died within 14 days after the cardiac arrest. The deceased patients had increased S-100 levels on days 1 through 3 compared with survivors. All patients (100%) with an S-100 level of > or =0.2 on day 2 after the cardiac arrest died within 14 days, and 89% of the patients with levels below this limit value survived (positive and negative predictive values). The corresponding predictive values on day 1 were 71% and 85%, respectively.


CONCLUSIONS
The present study shows that hypoxic brain damage after cardiac arrest can be estimated by measurement of serum S-100 concentrations. The method can be used in early prognostic evaluation of short-term outcome after cardiac arrest.
Rosén
H
H
Institute of Clinical Neuroscience, Department of Neurology, Sahlgrens University Hospital, University of Göteborg, Sweden. hans.rosen@neuro.gu.se
Rosengren
L
L
Herlitz
J
J
Blomstrand
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000097:blood / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D002534:Hypoxia, Brain / Q000097:blood* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012151:Resuscitation; D009418:S100 Proteins / Q000097:blood*; D017741:Survivors; D013599:Systole; D013997:Time Factors; D014693:Ventricular Fibrillation
D015415:Biomarkers; D009418:S100 Proteins